Century-old hepatitis miscellany from Minnesota

bad way

The Pierz Journal (Pierz, Morrison County, Minnesota), 1915-12-02

1915

In a Bad Way

“Where are you off to in such a hurry?”

“To fetch the doctor for my husband.”

“What’s up with him?”

“He tells me he has got hepatitis, dyspepsia, rheumatism, enteritis, gastritis, appendicitis, nephritis and cerebro spinal meningitis.”

“Holy terrors!  Where did he get all that?”

Why a man induced him to buy a medical dictionary, and he’s just been reading it.”

______________________________________________________________ Gee, folks with virulent liver trouble had it made in 1911–only 25 cents for Dr. King’s New Life Pills.

jaundice

Starts Much Trouble. If all people knew that neglect of constipation would result in severe indigestion, yellow jaundice or virulent liver trouble they would soon take Dr. King’s New Life Pills, and end it. Its the only safe way. Best for biliousness, headache and dyspepsia, chills and debility. 25c at E. L. Kaliher. The Pierz Journal (Pierz, Morrison County, Minnesota), 1911-11-02

______________________________________________________________

Old-timey MN remarks on a British Lancet article.  Anyone with a history hepatitis knows the itch referred to here in 1937.

itch

Itching Pruritis. It has been truly said that “all the world itches, but for different reasons in different persons.” Thus the very cleanest and the very dirtiest individuals itch; those who perspire too much or not enough, itch; those who are big eaters and those who are small eaters, itch. Itching, or pruritis as it is called by physicians, when it exists for any length of time has usually been referred to a skin specialist. However itching can be a symptom of so many ailments that is is really the work of the family physician, according to an article by Lord Horder in the British Lancet. He mentions among other causes of itching such ailments as diabetes, jaundice, leukemia (great increase in the white corpuscles in the blood) and uremia (waste products left in the blood that should have been removed by the kidneys). The Pine River Journal (Pine River, Minnesota), 1937-04-01

________________________________________________________

But, not to worry, there are new remedies in the 1930s for sale:

liver

The Pine River Journal (Pine River, Minnesota), 1938-03-03

Catarrhal jaundice is now known as HAV. It is described in reports like this 1901 outbreak in the UK (LINK).  But even as late as 1961, researchers thought there were at least two strains of the virus but were still floundering around–as expert W. Paul Havens explains in Viral Hepatitis, Yale J Biol Med. Dec –Feb 1961-2; 34(3-4): 314–328., (LINK).

The Havens article also provides a sense of how a big a problem hepatitis was for the military during WWII.  This corresponds with this chart by Google showing the use of the word “hepatitis” in books over time.  Yet even in the 1800’s, when books (in English), or physicians, were not as available as they were in the mid-19th century, the topic is one of steady concern

hep ngram

Google’s search for the word hepatitis in BOOKS shows that the mentions begin to rise in the mid-30’s and takes off in the 1940s as a hot topic.

 I’m pleased with these finds and know they are just the “tip of the iceberg” in terms of the history of likely hepatitis strains in the U.S. population.

Posted in HCV Health, HCV Risks (documented), Medical News, Military Madness, Presumption of Regularity, Vietnam Disease Issues | Tagged , , , , , , , , , , , , , , , , , , , , | 2 Comments

CAVC–BIRTH OF A WRIT- ACT III SCENE 8-DOWN FOR DOUBLE

vetcourtappealspromoA short while ago in VA time, when I won my claim in June 2008, I noticed they (VA) forgot to go back to 1994. That wasn’t a deal breaker. I knew they weren’t going to pony up without a good fight. What I didn’t see coming was the rater, Victor Morales convincing  me to throw in the towel on my newly filed claims for cryoglobulinemia and fibromyalgia. I didn’t know I was going to win the Hepatitis and porphyria claims when I filed them. I felt it was prudent to file for any that might kill me.

When I was told of the big 100% win over the phone, the rater said there simply was no higher rating and it might be a good idea to let some of the other Vets in line get a shot at justice, too. I readily agreed and withdrew the claims. Unbeknownst to me, they were completely developed and ready to rate back in September 2008 when I pulled the plug. There they have sat complete with private doctor nexus letters for seven years.

images

Dad and crew chief in November 1944 (only three kills on canopy)

When the VA tipped their cards and indicated they would not be granting the Motion to Revise my 2008 rating, I figured I needed a down for double path to an extra 60% to attain SMC S. I had 40% for porphyria and 10% for tinnitus. In VA math I needed another 20% for anything to get to the S rating. My two diseases above would grant me enough to reach the 60%. Problem solved. Unfortunately VA buried them somewhere and never made any effort to decide them. Fast forward to March 2015 and a red hot Writ.

In typical fashion, VA chose to run around the vehicle in a Chinese fire drill. They granted the SMC S under another method  but still continued to develop the Cryo and Fibro. Had they a good negotiator, we could have saved them oodles of time. Mr. Mark McNabb could have  offered to teleconference with LawBob Writpants and make some quick off the book deals which would have been greeted fairly. Instead, in true OGC fashion, Engine #6 was dispatched to 625 Native American Ave. NW and Mark was instructed to put out the fire poste haste and call in another ladder truck and a tanker if necessary.

Several days ago, on Friday, I attended my required C&P examination for cryo and fibro at QTC. Everyone including the doctor was swell. Cupcake helped me in and out and we both told a sordid tale of a year in the VAMC, bodily insult and infections. Dr. _________ gave me the exams which involved an oral interrogation for the cryo symptomatology and the pressure points to ascertain Fibromyalgia. A quick tube of blood and we were history. Coming out, a fellow Brother of the Red Clay had a lovely bumper sticker I must possess.

Vietnam — We were winning when I left.

downloadThe naming of this chapter is a memorial to my father. His fighter in WW2 was named the same -Down for Double. Dad was very fond of this Blackjack trick. It often guaranteed two payouts. He also was fond of keeping the sun at his back in true fighter pilot fashion. Don’t worry about your six. That’s your wingman’s job. Concentrate on the hunt. The hunt here was for that elusive 100% for porphyria but now VA has compounded the bet by forcing me to go down for double. When all is said and done, my actual rating may be well over 250%.

Excuse me but this is becoming ludicrous. I want them to husband scarce judicial resources and grant that which is blatantly evident in the c-file. VA is so obsessive-compulsive they feel obligated to proceed strictly by the book. Considering McNabb has great leeway to “arrange” these things, one can only wonder at the Keystone Cops comedy that is unfolding each day. Cupcake counted three assistants and the doctor at the C&P. That will run about $ 850 for each exam.

Add in turning the Seattle RO into an exclusive claims center for one Vet all week on the 17th through the 27th of February and you’re talking some serious baksheesh.  Across the country McNabb and his little people put a dent in the National debt over the same period.

I feel at this stage as though we are dealing with the Gang who couldn’t shoot straight. All you budding law dogs should take note. This isn’t a claim on appeal and OGC’s staff attorney is normally precluded from addressing you directly. The accepted way to proffer a repair order would be to do it in the Respondent’s response and retire gracefully. VA is still trying to play the incremental game of slowly advancing your token up to 100% from 10%, then 40% and the latest 60%. We are at seven years on this now and I grant you they have reached 60%. That last hurdle is what we will negotiate in the next few days.

It never ceases to amaze me how many resources can be deployed to defeat a Vet for such a long time to stave off the inevitable. Surely, someone with basic forensic claims skills could have fathomed this. You don’t need Hooked on Phonics to accomplish it. Nevertheless the Blind continue to lead the Deaf and get well-paid for it. I cringe to think how much time and money is being squandered to fix something so obvious for so long. We look at this claim and see the rot, the entrenched mindless regimen and the futility of accomplishing anything in a timely fashion.

FOPEJV1HLZROC8J.LARGEThe next few days will be anticlimactic and then Judge Davis will inveigh. That will be the “fat lady singing” moment that indicates it’s over. Or not. Could be McNabb will become incensed and throw down. Stay tuned. I’ll remember to keep the sun at my back. LawBob is my wingman so it’s his job to cover my six. He seems to be doing that quite well.

 This is a continuing series on how to file an Extraordinary Writ. Click here to read the final installment. All in all it was quite successful in provoking Secretary Bob into acting.

https://asknod.wordpress.com/2015/03/22/cavc-birth-of-a-writ-act-iii-scene-9-welcome-to-the-hotel-california-again/

Posted in AO, BvA Decisions, C&P exams, CAvC HCV Ruling, CAVC Knowledge, CAVC ruling, Earlier Effective dates, Porphyria Cutanea Tarda, SMC, Veterans Law, Vietnam Disease Issues | Tagged , , , , , , , , , , , , , , , , , , , , , | 15 Comments

CAVC–BIRTH OF A WRIT-ACT III SCENE 7–I’LL SEE YOUR ‘ME WORRY’ AND RAISE YOU 10

vetcourtappealspromoIn a poker game, you don’t want to scare them off with a superior hand, but rather inveigle them to see you and raise yet again. We’re playing VA poker here so I want to convey the futility of further bets but let Mr. McNabb depart with his dignity and his pocket watch and fob. He is free to fold gracefully-as he should. I firmly believe he is at liberty to do this and is not being pressured to hold the line by higher ups. By the same token, he has delegated far too much authority to the Seattle RO and little people like VSCM AynMarie Lofgren. 

The CAVC is an august body who is legitimately head and shoulders above the legal riff raff  in Seattle as well as the OGC. They will not take lightly the stance of  a Veterans Service Center Manager telling Veterans they will get their c-file when it is damn well “ripe for copying”. Nor will they cotton to a condescending attitude of “semi-compliance” after a dilatory twenty two year lesson in how not to adjudicate claims. As for Mr. McDuff’s belief that a score and two years hardly meets the threshold of a refusal to act, I look forward to Judge Davis’ opinion.

Miz Lofgren has been hung out to dry by Mr. McDuff’s inattention to law business. He allowed her to use hangman’s language in her affidavit. She could have correctly stated  it based on “information,  knowledge and belief “instead of the much higher standard of a stack of Bibles with her right hand raised. She has been fed the OGC Koolaid and inadvertently perjured herself in the offing. Bummer, Ayn. Did they promise you a performance bonus?

Poker-Clip-Art_straightTomorrow the sun will rise in Seattle but Ms. Lofgren will be busy seeking legal counsel to extricate herself from her falsehoods. Mr. McDuff will be looking at his hole cards and making plans to either bluff again or fold. I never thought it would come to this to be truthful. But then I miscalculated VA’s entrenched intransigence.

Motion of Petitioner to Strike affidavit

I take no pleasure in wreaking havoc on these folks. I have given them ample time, in my view, to comply. Their recalcitrance is incomprehensible in light of the weight of evidence against them, yet they refuse to chieu hoi. What part of non adversarial was lost in this twenty two year dialogue? What did I say or do to offend them? Unless I am mistaken, ’tis I who is the aggrieved party.

This is one in a series on how to file a Writ and win it. To see the next chapter click here:https://asknod.wordpress.com/2015/03/08/cavc-birth-of-a-writ-act-iii-scene-8-down-for-double/

Posted in CAvC HCV Ruling, CAVC Knowledge, Earlier Effective dates, Extraordinary Writs of Mandamus, Vietnam Disease Issues | Tagged , , , , , , , , , , , , , , , , , | 8 Comments

CAVC–BIRTH OF A WRIT ACT III SCENE 6- WHAT? ME WORRY?

vetcourtappealspromoI have to hand it to the VA’s Office of General Counsel. With perfect aplomb, Mr. Mark M. McNabb, a mid-level supervisor/litigator for OGC, filed his notice of appearance and the Government’s response to my Writ.

 Perhaps, by being mid-level, he’s not privy to what the Fed. Circus is handing down as precedence these days so much as at the Court. Law is so mind-numbing when it cuts into Twittertime. Perhaps that’s why he forgot  overlooked the fact that Kyhn v. Shinseki 716 F. 3d 572 (2013) put a fork in the practice of continually shoving new evidence in under the  CAVC tent like an intrusive camel’s nose. 

OGC’s Faery Tale

downloadJust in case, I sent him an email to read this so he can “freshen up” his next response. (no. just kidding, Bob) In a nutshell, VA tried this padding of the Record on Appeal back in 2012 to roll Arnold Kyhn on his appeal. The OGC showed up with  some “affidavits” from several VA shills who testified how the mailing process works so that the Presumption of Regularity of the Mail could be preserved. One little problem. Congress put a fork in this way back in 1989 with the VJRA when they said the CAVC decision must be based solely on the evidence of record. You can see where it might seem a tad unfair that VA can sashay on in and add anything they want to “fix” it so everyone can get a handle on the facts  more clearly. However probative and informative the affidavits were was a moot question. VA had plenty of time to introduce those at the BVA. The appeal to the Court must rise or fall on it’s own merits sans any post hoc PowerPoint™ Presentations by helpful VA employees. So you can imagine Counsel’s (mine) consternation when he spotted Veterans Service Center Manager (VSCM) Ayn-Marie Lofgren’s affidavit  chock full of handy dandy explanations of shoes–and ships–and sealing-wax–of cabbages–and kings–and why the sea is boiling hot–and whether pigs have wings.

Imagine for yourselves the confluence of events and people about their normal occupations at the Seattle Regional Office (346) on any given day. Now imagine one Veteran-one out of say 300 or 3,000 or 30,000- with pending claims, appeals awaiting certification for the odd CUE claim to revise a decision made in 2008. Add in another appeal for an Independent Living Program greenhouse grant. Add in a pending Joint Motion for Partial Remand (JPMR) for grant of earlier effective date growing old, musty and unfinished. Now, imagine that all Big Mac’s Horses and all Big Mac’s men suddenly converged on one Veterans’s claim on the same day and at precisely the same moment-quite by chance, mind you. The odds are stupendous that all this could be done in concert- let alone without ten individual copies of an eleven-volume c file that has never been digitized. According to the DRO, there was one, and only one, on October 3rd, 2014.  Nevertheless, this is what Ms. Lofgren’s affidavit purports to show. The wheels were in progress on this long before I filed my Writ. It’s merely that ol’ “confluence paradox” that needs little or no explaining. But, since I asked, Ayn-Marie will expound on it in Dick and Jane speak to assuage my fears and show me my $50 filing fee was a poor investment.

VSCM AffidavitVSCM Affidavit_2VSCM Affidavit_3

Could it be believed, the stars aligned so perfectly on February 17th that one would tend to search for Sagittarius on the cusp of Aries. I should have invested in Tesla that day. Perhaps renewed my wedding vows. Days like this just don’t happen unless…  unless maybe Miz Lofgren was funning us. There’s one little problem we detected. Columbo would have spotted this with one eye. There were fingerprints on the bullet inside the gun. If you want this to look convincing to a CAVC Judge, you simply have to do a better job of arranging the crime scene.

The first problem is that our observant VSCM was only recently assigned to the Seattle RO in April of 2014 so anything that transpired before her tenure there cannot be attested to under oath as she did on items II – V, XIV, XV and XVIII. Being generous, I would say her credibility has been severely compromised.

Item XI states that the rating decision was adjudicated February 19th but my Ebenefits shows it closed on the 17th.

 

Capture cryo fibro complete 2-17-15

What’s truly amazing about this is the pace of progress. I’ve helped hundreds to learn the ins and outs of eBennies. Never have I seen a decision published on the site in less than three days following the promulgation of the decision-let alone before being signed around for the requisite three signatures to release more than $25,000.00. Moving on…

Item XII states a SSOC was issued February 17th, to help Counsel better understand the denial of a higher rating for Porphyria that would not be adjudicated until two days hence (February 19th). This is what we call the DeLorean Conundrum. It’s Back to the Future litigation.

XVIII clearly states I have a claim pending for Cryo/Fibro filed October 2, 2012 yet the above screen shot shows a) it is no longer pending and b) Ms. Lofgren could not be personally cognizant of this event two years before her arrival. Judge Judy calls this Hearsay.  In Courtspeak, that’s inadmissible.

XX scares me the most. The Veterans Service Center Manager of my Regional Office has just thrown down the gauntlet and  announced she will convert my c-file into an electronic format “when the file is eligible for scanning”. How would one view, let alone review, the file to plan a defense for the future appeal(s) without it? Doesn’t the term “due process” reverberate around in the skulls of any of these folks?

Now for the icing. If Ms. Lofgren can be believed, it just so happens that the Tacoma QTC was contacted to set up a compensation and pension examination that very same auspicious February 17th I was remarking on above. The obvious fingerprint on the bullet ensconced in the gun now has a name. If the claim is still waiting to be adjudicated as described in XVIII, how can it be that it is an appeal? Item XVIII also states this claim was filed on October 2, 2012 yet the DRO transmitted it to QTC as an appeal with an effective date of August 12, 2012. This is like the immortal Traffic Song of the sixties You can all join in:   “Make your own date up if you want to/ Any old date that you think will do”.

QTC

qtc 2

 

I have asked Lawbob  Writpants to file a motion to strike this flawed document from the record. If this is the best answer Mr. McNabb can muster, VA should retire from the field of battle and be declared hors d’combat. Unfortunately, there is a high probability that Judge Davis would be generous to our Mr. McNabb because he is normally very courteous to these VA folks. I feel every motion we can file that is appropriate -and salient-should be. I’ve always been a big fan of enfilading fire. Why waste bullets? Let them run into the bullets. This becomes the template for many who will follow in my steps. Gordie and his mother Jean Erspamer are looking over my shoulder. Gene Groves is also front and center in an effort to help fine tune it. We want the compendium of the evidence to be an egregious insult to the intelligence of the Court.

As for Mr. McNabb’s observation that twenty two years of sitting on the Group W bench patiently waiting for justice hardly amounts to a refusal to act, I would point out two things. He cites to Jean Erspamer and Mr. Costanza as being the bright line rule. Jean waited 10 years for her decision. Mr. Costanza had no standing as he merely had eleven months on the bench. Neither approaches my record twenty two years in limbo nor the calluses on my derrière. Nevertheless, McNabb says the wait does not represent the “extraordinary circumstances” that would precipitate a grant of the Writ. Perchance  a delay of several generations of Grahams, to say, my unborn grandson’s before remuneration delay would be considered “extraordinary” is the metric Mr. McNabb feels is appropriate?

As for this insane argument over 100% versus 60%? Idiot’s delight. You can see the hubris well up in their breasts as they steadfastly refuse to entertain the 100% semantic tar baby named “Totally disabled”. Item VII  might have been written by Judge Hindin himself. “Mr. Graham expressed his objective was to obtain an increased evaluation of 100% for PCT effective March 31, 1994.” Good Heavens! The greedy Vet revealed his cards? Quick. Write a stinging rebuke and tell him it won’t be arriving until the Second Coming of Christ. And they did. Three days later (see VIII).

One thing is for sure. The OGC dallied until the very last day as we suspected they would to accomplish as much as possible. They filed at 1838 Local on the new, happy NW Left Coast which was a mere two hours and twenty eight minutes before the carriage and four-in-hand reverted into a pumpkin and mice. Bravo. Mr. McNabb. A grateful Veteran salutes you for your yeoman service and perseverance to try to get it right lo these one score and two years. Pardon me if I take on a Missouri-like scepticism and ask you to just show me.

Here’s Bob’s latest Opera Dei.

Petitioner’s Response to Respondent’s Faery Tale

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Hey. Ne problemo, right? All’s well that appeals well.

We are now at Launch plus fifty seven (57) days. I’ m sure I mentioned back in January this  would be VA Ratings on steroids at 78 RPM. Stay tuned. This is almost over- just in time for the NOVA Conference in April. My, what another odd coincidence.

This is a series in Birth of a Writ. To read the next installment please click here

https://asknod.wordpress.com/2015/03/05/cavc-birth-of-a-writ-act-iii-scene-7-ill-see-your-me-worry-and-raise-you-10/

Posted in CAvC HCV Ruling, CAVC Knowledge, Extraordinary Writs of Mandamus, Porphyria Cutanea Tarda, SMC, Tips and Tricks, Vietnam Disease Issues | Tagged , , , , , , , , , , , , , , , , , , , , , | 5 Comments

The VA’s Improved Transportation Service in 2015

va van

Many veterans who are currently eligible for VA health care benefits and have a VA authorized appointment are eligible for VTS. Every medical center has made up it’s own rules on who can get a ride on the shuttle. Some are  very restrictive.

Not everyone will be able to ride the bus.  The links below should take you to the VTS phone line in your location.

Scheduling a ride to the VA may get easier for vets living within 20-miles radius of a center in Minneapolis.   But this should help veterans who most need help with transportation and aren’t too far from a VHA.  It should help reduce appointment “no shows” once the word gets out. “No shows mean that a different vet had to wait longer for an appointment.  It will probably reduce the VA’s travel outlays once it gets going and pay for it’s self when word gets out.

To enhance the VHA system, the Central Business Office (CBO) is launching a new transportation program for immobilized and remote VA patients to enhance existing programs implemented by local VA Medical Centers (VAMCs).  Veterans Transportation Service (VTS) seeks to provide transportation services to include vehicle routing/scheduling software for VA Medical Facilities. The ride scheduling and routing systems will include GPS modules for VTS vehicles.

I organized a brown bag picnic by a lake for some of the oldies here on a A/C van just like this.  There was room for walkers and a scooter. It was fun for those who don’t drive to be picked up, dropped off, and then returned home after lunch and doing some walking.  It cost everyone $3.00 for a pleasant outing.

Posted in Guest authors, Medical News, VA Health Care, vA news | Tagged , , , , , , , , , , , , , , | Leave a comment

CAVC–CLARK V. SHINSEKI–YOUR MOMMA’S LYING

vetcourtappealspromoWhen you get to the CAVC, you at least get the Judge, or more appropriately, the judge’s little people, to thoroughly investigate a case; this in a far more balanced perspective than the slanted judicial Titanic deck of AOJ and BVA where they keep rearranging the deck furniture (the facts) to keep them dry.

Meet Mr. Edward Eugene Clark, a Veteran of the Cold War front in Germany. You can tell right off the bat that if Gene’s Grandma and Mom journeyed to Fort Jackson, South Carolina to see him after he got a heapin’ helpin’ of southern fried jetguns in 1972 that he probably was sick. Maybe not sick with a capital S  but enough to get momma on the warpath to Fort Jackson on a Greyhound with Grandma in tow for mutual comfort and support. I find women often travel in pairs when in distress. If you have two irate mommas coming after you as a medical professional, you better have majored in Public Speaking. We’re talking 1972. You can’t get a word in edgewise.

Gene Clark’s adventures in Indianaland

Six weeks after my son enlisted and was in boot camp, my mother and I visited him at [the] Fort Jackson[, South Carolina,] hospital, along with several dozen young men that seem to be affected by the same thing. We were never told what he had. Several weeks before his illness, when he was being inoculated for several things that are required by the [A]rmy[,] Gene described to me the condition of the pneumatic injection system used by the military. He described the condition of the apparatus[] as being covered with blood, skin, and pieces of flesh after dozens of soldiers had been inoculated ahead of him.  Clark v Shinseki (2011).

Sound familiar? Flu-like symptoms and prolonged fever? I’ve heard that so many times from a lot of you. Sounds a little like my jet gun indoctrination. I can’t say that I became ill though. I came down with it in full bloom along with Hep. B in 1971 -89 days after a minor encounter with an errant 7.62 rd.

downloadGene also had a claim in for his back that devolved into a nexus war. Let me show you how VA can build a medical record out of thin air. The blue below is VA examiner #1 who lays the groundwork for #2 (in red) who comes in behind a year or two later and pours concrete around #1’s “ruminations”. The Board then turns that into a rebuttal of the Presumption of Soundness(in purple) Note Examiner #1 uses terms like “If it was indeed a…” and “might be“, “I am unable to determine definitively“, etc. The Court has routinely labeled this as equivocal mumbo jumbo that leads to “probably not a good idea in my Courtroom.”  He admits he had a “back event” in the cervical area of the spine before service. He was declared sound for enlistment. He injured his back thrice in the service. That is all you need to know. He had no post-service injuries -just “surgical interventions” which do not constitute an injury. Well, unless you’re using a 26 year-old VA back surgeon named José with a MD from Guatemala Witch/Medical Doctor University. That’s why they wrote 38 USC §1151.

In the 2006 VA-ordered C&P, the examining physician (or ARNP, CNA, RN, LPN, bedpan changer) opined thusly:

In July 2006, Mr. Clark underwent a VA spine examination. The examiner stated that he reviewed Mr. Clark’s claims file. The examiner recorded (1) two pre-service back injuries; (2) three in-service injuries, two of which the examiner noted were not in Mr. Clark’s service medical records; and (3) three post-service “surgical interventions,” including spine injections.

After a physical examination, the examiner gave an impression of “[s]tatus post[- ]L5-S1 posterior lumbar interbody fusion” with “intermittent radiculopathic pain.”

‘To give an impression of’ translates into “Most doctors, but not all, might think it’s …” Radiculopathic pain is pain that shoots down out of your back/hips and into your leg. I have it from an unscheduled aircraft landing in what VA would probably call a sylvan (forested) setting..

In an addendum, after reviewing x-rays, the examiner opined: I think his back injury is related to [his] lumbar symptoms[,] so I do not think the cervical spine injury when [he] was 16 is related. However, I am unable to determine definitively if an injury to his lumbar spine in 1972 might be related to his current symptoms. I do not have x-rays to review; however, I think if it was indeed a mild lumbosacral strain that it is probably less likely than not that this injury is the cause of his current lumbar symptoms.

Sounds like someone who is conflicted until the thirty pieces of silver come out of the pouch. Okay, so far so good. You couldn’t convict OJ Simpson with that. Now we advance to Examiner #2 who will pick and choose select words, dodging the “might be related”s and the “do not think”s. Examiner #2 will create medical facts such as this brand new diagnosis:  ” if it was indeed a lumbosacral strain” metamorphoses into something entirely different below. Surgical interventions likewise loses it’s postcedent “interventions” and is abbreviated as “multiple back surgeries” now. Kind of reminds me of my fishing buddy Wade. Them fish got huge after a few years.

In October 2008, VA requested another spine examination, apparently under the mistaken belief that one had not yet been provided as directed by the Board’s June 2006 remand decision. [I’m so sure!] Later that month, a VA examiner reviewed Mr. Clark’s claims file and conducted an examination. The examiner noted two pre-service and three in-service back injuries, as well as three post-service surgical interventions. The examiner recorded Mr. Clark’s current complaints and symptoms and [T]he patient’s back condition is less likely than not related to his in[-]service lumbar strain. The patient is 53 years old. He has had multiple back surgeries. He had an injection beginning in 1983 and surgery in 1989 and 1995. These can certainly be from age[-]related changes or other just normal activities of life. Additionally, the cervical injury of 1971 from wrestling and the automobile accident [of] March 1972 with a diagnosis of lumbosacral strain, although he was asymptomatic on entrance exam[,] it is less likely not contributory to his current back condition.

Gene now carries a diagnosis of L5-S1 strain now instead of the more severe “injury” in Examiner #1’s C&P. Get used to this technique. In the process, they have just eviscerated his Presumption of Soundness in purple.  He also had numerous surgeries he’s plumb forgot. Now watch them do something similar to him on the Hepatitis C claim. Here’s Veterans Law Judge Vito A. Clementi’s version of how it went down:

Gene’s BVA decision.

 It is wholly unworthy of belief that medical services personnel of the U.S. military, in a peacetime environment and engaged in an activity directed towards ensuring the health of its members, would engage in such patently negligent performance of their duties so as to not ensure the hygiene of such [jetgun] immunizations.

As to [Mr. Clark’s] account of “stepping on needles” used by heroin addicts, it is also inherently incredible that [Mr. Clark], presumably knowing of his roommates’ predilections, would not have immediately reported to sick call instead of waiting over 20 years in this attempt to gain VA compensation. [His] allegations are contradicted by his [service medical records] which show that [he] never made a single complaint related to be stuck by an infected needle or scratched or bitten by other servicemen who were heroin addicts.Clark supra

Now let’s see what Judge Hagel’s minions had to say about that.

The Board essentially denied the existence of the second element–in-service incurrence– because it found that Mrs. Clark’s statement regarding Mr. Clark’s description of the circumstances of his inoculation was not credible. The Board did so because it simply could not fathom that the U.S. military would act in such a negligent manner. This conclusion is devoid of any actual analysis and is insufficient to support a finding of incredibility. See 38 U.S.C. § 7261(a)(4); Wood v. Derwinski, 1 Vet.App. 190, 193 (1991); Gilbert v. Derwinski, 1 Vet.App. 49, 52 (1990). At no time did the Board discuss military procedures for inoculating recruits during the period at issue, nor did the Board consider that such “negligence” is only negligent in hindsight: that is, what we today would consider a dangerous and unsafe practice as a result of the relatively recent understanding of blood borne diseases might have been standard practice at the time of Mr. Clark’s service. See VA Fast Letter 04-13 at 1 (June 29, 2004) (regarding the blood-borne nature of hepatitis C). Clark supra

The above in red is why I chose this decision. This will give you valuable ammo to cite when the next VLJ bozo comes out with a cogent “”That’s incredibabble” in your Hep C denial. See this as well:

The Board also found Mr. Clark incredible with respect to his statement regarding exposure to dirty needles used by heroin addicts and to being bitten and scratched by heroin addicts because of a lack of documentation in service medical records that he ever voiced his concerns about these events or sought treatment for bites or scratches. Although the Board characterized this as evidence weighing against Mr. Clark’s credibility and, ultimately, his claim, it is actually the absence of evidence, which is not the same as negative evidence. See Kahana v. Shinseki (2011) ; McLendon v. Nicholson (2006) Clark supra

Decisions like these are how we lose and think we never had a case. Words really do hurt. Everybody knows that-just like when Jesse blew off Nell and left her. You remember. He rode off on horseback into the “E” in The End in that car insurance commercial. What more proof do you need?

download (1)

Jesse?

Hang around me too long and you’ll need a shrink or a six pack of beer every hour. But that’s not the teaching moment. VA’s proclivity to cheat is.

Posted in BvA HCV decisions, CAvC HCV Ruling, HCV Health, HCV Risks (documented), Jetgun BvA Decisions, Jetgun Claims evidence, Nexus Information, VA Medical Mysteries Explained, Veterans Law | Tagged , , , , , , , , , , , , , , , , , , , | 3 Comments

VA training book, “How to Lie with Statistics,” outed

book

Screenshot from gov. hearing by C-Span

Did you happen to catch this story last (CNN video–6 minutes or AZTV) fall? The best-seller was studied at the VA until 8/14 when Sec. MacDonald pulled it from training programs. The book is not promoting lying per se but Huelskamp (Kansas), who sits on the Veterans Affairs Committee, doesn’t like it one little bit.  Rep. Huelskamp claims to know plenty about statistics from his Ph.D.. In any case,  who can resist a banned book!  (What, no protests from the American Library Association over this outrage?)

owl-ebook

“How to Lie With Statistics” $7.99 Kindle version “This book is a sort of primer in ways to use statistics to deceive…. The crooks already know these tricks; honest men must learn them in self-defense.” Grahic: openclipart.org

I’m joking about the ALA because I love librarians and their often unpopular stance on the freedom to read–everything.  But Rep. Huelskamp does make an important point about how data can be visually presented with graphics that give a wrong impression; he calls the VA out on one example. Actually, I want to read this book because the title is satire and with the catchy title, it’s sold a ton of copies.

I’m looking forward to reading Nate Silver’s book, The Signal and the Noise which is supposed to put statistics into contexts laypeople can relate to.  Amazon delivered it and it’s calling to me.  Although I got a decent grade in a required introductory statistics in college many moons ago, I struggled with the subject.  But given all the research I’ve been reading, I have to tackle this subject again so I can spot some statistical trends or lies.

 

Posted in Guest authors, Medical News, Nexus Information, Tips and Tricks, VA Health Care, VA Medical Mysteries Explained | Tagged , , , , , , , , , , , , , , , , , , | 4 Comments

Today’s trip to a non-VA ER

Walking the beagle led to a nasty fall on snowy concrete for my old Marine this afternoon. He entered the apartment (cussing at himself) with blood streaming out of his nose, cuts on his hand and a knee screaming “pain, pain!”  With a small hospital is less than two miles away, he insisted on driving himself. Two hours and several X-rays later, he arrived home with his red broken schnoz, bandages, and pain pills.

Nurse-Practise

I’m really glad he bought a Medicare Advantage Plan ($48.00 month w/o drug coverage), reasonable ER visit co-pay ($65.00), and 10% X-ray co-pay as a back-up.

I called the VHA hospital in Minneapolis and reported that he was in the ER.  The switchboard put me through to the VA ER.  A VA-ER staffer said to call back when he either is admitted or discharged.  So I did.  The ER staff pulled up his record, asked a few questions about the trauma, and that was that.  Said to send in the unpaid bills in case he’s eligible for any payments on them–and wished him well (typical of all the nice Minnesotans).  The VA staff was fast and efficient.

Will the VA pick up the costs his Medicare Advantage Plan will not since he didn’t call for non-VA ER care prior-authorization?  I cannot tell from this VA webpage (LINK) or Fact Sheet which problem he might fall under.

If someone has other insurance, including Medicare, they can refuse to be a payer. Will his Veteran’s Choice Card help?  Maybe because the VHA is not “feasibly available” to him (LINK):

A preapproval for treatment in the community is required for non-VA medical care – unless the medical event is an emergency. Emergency events may be reimbursed on behalf of the Veteran in certain cases. –

 

er va

CLICK IMAGE TO READ FACT SHEET

TRICKS & Traps Alert:: Under the “Mill Bill,” he has 90-days to get a claim in using form VA 10-583.  It’s a shorty.  Only one page to fill out and attach bills. Since insurance companies can take well over 90-days to pay, I think it’s prudent to send the form in next week without the bills, a copy of his coverage, and letter to say bills will be sent in as received.

So this is a real-time test of a real event and if the VA will help us with this emergency and after Congress has filled the coffers with funds for non-VA care. Our experience will be based on his individual circumstances versus rules we can all understand and rely on.  As they say on shopping forums, YMMV (Your Mileage May Vary).

Posted in Guest authors, Medical News, Medicare for VETS, VA Health Care, VA Medical Mysteries Explained | Tagged , , , , , , , , , , , , , , , , , , , , , | 2 Comments

BVA–THE SILVER QUEEN OF BALTIMORE

NodsterSurely over these last five years or so, you have heard me opine on members Leigh and Paul. They feel like family now to Cupcake and me. So it is with great pleasure that I finally induct them into the HCVets Winner’s circle. This has been a long, long battle and I feel it needs telling. 

Leigh served in the Navy during the period before latex gloves and sanitary precautions. She had a double whammy of jetguns and very invasive oral dental surgery in the 80s. She met the love of her life Paul, an ex Marine, as she was leaving the service and they have been together ever since. When she finally became ill, she and Paul started scouting for what could possibly have infected her. They filed for VA comp. and promptly got a vicious slap in the face.

VA stated that her pelvic inflammatory disease was an indicator of promiscuous behavior. The VA examiner further opined it was not incurred in service. Alternately, a small India ink tattoo applied when she was 12 with a sewing needle was undoubtedly the cause of the HCV. Basically it was anything but a jetgun or having molars excavated with a dentist’s jackhammer.

About that time they found me. We set out to build the perfect case. We had her John Hopkins liver transplant doctors write several nexus letters. Wait. I forgot to mention her liver crapped out in 2011. The Hep C promptly infected her new one. Imagine having to eat immune suppression drugs to keep her body from rejecting the new liverbox while it allowed the Hep to run rampant unchecked destroying it. It was a vicious circle.

The tale of woe began to go downhill when they tried to get their c-file to defend themselves and help win it. Baltimore’s RO ignored her repeatedly. After a year or two, I suggested a Writ. I finally suggested they go the attorney route because VA was laughing at her- not with her.   They armored up with none other than Keith Snyder, the mild-mannered Clark Kent type of guy who always gits ‘er done.  Sure enough, just like my writ for justice,  this produced quick results but they were still dogging her with an incomplete file. The story sped up when they filed for §20.900(c) to advance her on the docket.

Mr. Snyder did an admirable job as did Dr. Ben Cecil again. Armed with three good nexus letters, VA rightly caved in with their weak VA examiner nexus that wasn’t even plausible. I’ve held their hands in times of despair and setback. I’ve given them every piece of knowledge we have amassed over the last fifteen years of fighting these things. Rarely did three days go by without a pow wow. Last week the hard work culminated in Leigh’s win. I had far more confidence in this than they did. I told them and I’ll tell anyone that will listen. This is a recipe just like baking cookies. There are no shortcuts from the batter to the cooling rack. In Leigh’s case, the VA did a magnificent job of keepaway with her benefits for almost six years. Six long and painful years, I might add.

Leigh and Paul filed back in 2009 and got the first wave off in 2010. A DRO denial decision in January 2011 sent this to DC. Unfortunately, as most know, the VA seems to be using UPS Underground which digs a tunnel there. Then the c-file was unavailable. Baltimore’s RO was so booked out on backlog, they sent it to Providence Rhode Island for a DRo review and then to Detroit.  Go figure. Detroit was shipping their stuff to Fort Harrison by then. About the time she asked for a copy of her c-file, Detroit claims it sent it to Cheeseville. Everybody shrugged and acted like there were no flies on them. Fingers pointed everywhere but to Detroit.

Wounded Warrior Queen Leigh, son and Paul.

Wounded Warrior Queen Leigh, son and Paul.

Here’s the OGC’s Monday Morning Quarterback report. No EAJA for Keith either. After two years she got the files so what’s the beef? It’s not like they told her to get lost permanently. This jurisprudence casts a pall over Vet’s access to justice via qualified legal help. Why would an attorney even want to help a Vet like Leigh file a Writ if they can’t recoup the EAJA? It’s not like the Vet wins any money in a writ. In most cases, it’s a last ditch attempt to get what you need to prove your case.

Leigh’s Writ answer from VA.

Leigh’s Writ answer from Judge Davis

VA skated on this right up to Paul and Leigh’s ultimate win. They’ve been through a few boxes of kleenex and some long nights. I expect she’ll get a 100% P&T for the Hep alone. Being post-transplant, I can also see she’ll probably (or should) get SMC S for being substantially housebound. When you eat immune suppressors to prevent rejection of an organ, it leaves you open to every bug coming down the pike. Going out in public is taking a risk few would consider prudent.

We’ll naturally keep you posted as to the Big Brown Envelope from the Baltimore Prize Redemption Center. I think Paul and Leigh will be pleasantly surprised. You can’t get a transplant without losing one of your original 2,000 body parts. That’s pretty much 100% all by itself. Since they’ve waited for over six years for this, I think VA will want to be rid of them. Having Keith was their ace in the hole. Otherwise I could see VA stonewalling all the way to the court as they did me before granting.

Here’s the BBE from the BVA:

bva1bva 2bva 3bva 4bva 5bva 6

I call this a jetgun win. VA can say what they will, but our acting VLJ in tennis shoes has said it in no uncertain terms. Gene Groves filed a number of BVA decisions showing precedence and VA’s normal operating procedures to illustrate VA’s intransigence. We can certainly say this isn’t legal precedence but it clearly shows a unique style of argument to arrive at a win. That’s all that counts. It’s like Napalm or a Claymore. You simply have to get close.

As most know, Leigh and Paul own stock in Burpee’s seeds and have been drowning me in them. I just checked the freezer and I have about 40 quarts of Silver Queen left just in case they drop by for dinner. This is one of those wet eye posts for me. Leigh and Paul also were very generous for Butch Long’s false teeth funding drive. Rarely have I gone through this almost from start to finish with very many of you. Rob, Mark, Randy, Squidly, WGM- the list is growing ever longer than my memory. I can’t express the joy I feel when it happens. Sadly, for each of you we lead to a win, there are 30 who lose and never find this site.

Some say it’s futile to even try to conquer the behemoth VA. For them, I point to all the Leighs and Pauls that come back to share their wins with us. I leave you with this hope. I live by it,

644682_484919658207332_673615034_nIt made a difference for Leigh and Paul. I rest my case. I’d also like to personally thank God for allowing me to live long enough to get Leigh’s win for her.

Posted in BvA Decisions, BvA HCV decisions, HCV Health, HCV Risks (documented), Inspirational Veterans, Jetgun BvA Decisions, Medical News | Tagged , , , , , , , , , , , , , , , , , , , | 9 Comments

How HCV transmission could have been entirely prevented in medical interventions

downloadEven prior to the 1950’s, hepatitis transmissions were associated with diabetic treatments, transfusions, syringes, lancets, and the use of multi-dose vials. It’s taken decades for the CDC (and WHO) to get the message out but in the United States, the CDC’s One and Only One campaign is in full swing.  We owe it those who have died and will die from blood-borne pathogens from well-meaning invasive medical procedures, as simple as a diabetic pen, to get this information out.  

If you watch this training video or read the transcript designed for health care providers you will learn how this massive PAST harm was entirely preventable. 

CLICK ANY SLIDE IMAGE TO GO TO THE VIDEO ON YOUTUBE or view on the campaigns website here: (LINK)

hcv animation

Slide 12 Around 12 minutes into video. Animation!!! Image: CDC

We can see in the map below that bacterial injections are also a major concern but HCV seems to be the major focus of the presentation. The CDC does not include the Minot (ND) HCV outbreak among 51 patients and others where the cause is still being investigated. Nor does it include the CDC report on the jet injector transmission of HBV (MMWR June 13, 1986 / 35(23);373-6).

one and map slide three

 

prevention

“Wearing gloves and taking other infection control precautions aren’t just for your protection. The SIPC created this training to remind healthcare providers that the measures they take to protect themselves from bloodborne pathogens and other infection exposures, as required by the Occupational Safety and Health Administration (OSHA), also protect patients from healthcare associated infections. Injection safety and other basic infection prevention and control practices are central to patient and healthcare provider safety.” Image: CDC

Other highlights in the 20-minute training.  At about 5 minutes: Contaminated equipment info.  At about 6:13:  Viral hepatitis from unsafe injection practices.  At about 7:20 minutes: Drug diversion and HCV.  Exeter, NH case which we’ve covered on ASKNOD, is discussed.  At about 11 minutes, safer delivery designs are discussed;  about 12 minutes, blood back flow into multi-vials/ HCV contamination animation.  At conclusion, footnotes are given.

The training was published on YouTube in Dec. 2012 but has been viewed by under 9,000 people.

As mentioned, the use of multi-dose vials on jet injectors are not addressed but the concept is the same.  I predict that it will take private non-governmental funding to study the jet injectors which were in widespread use in the United States until our government withdrew their use after they recognized their threat to human health.

Posted in Guest authors, HCV Health, HCV Risks (documented), Medical News, Vietnam Disease Issues | Tagged , , , , , , , , , , , , , , , , , , , , , | 1 Comment